1105 JTP LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

1105 JTP LLC

Doing business as

genome pharmacy

Practice address

1105 Jericho Tpke
New Hyde Park, NY 11040-4603

Phone

(516) 775-7775

NPI assigned

Dec 27, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ishbay Shukurov

Title

Owner

Phone

(516) 775-7775

Specialties & licenses 1

Addresses

Other names 1

• genome pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1982243788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 JERICHO TPKE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110404603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 JERICHO TPKE",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110404603",
            "telephone_number": "516-775-7775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1105 JTP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-27",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "SHUKUROV",
        "authorized_official_first_name": "ISHBAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-775-7775",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "genome pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in New Hyde Park, NY
• Providers in New Hyde Park, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.